Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry

• DOI: 10.1055/s-0038-1623532
• Publication Date: 2018-10-24T19:15:22Z
• Authors: Albert Ariza-Solé; Carme Guerrero; Francesc Formiga; Jaime Aboal; Emad Abu-Assi; Francisco Marín; Héctor Bueno; Oriol Alegre; Ramón López-Palop; María Vidán; Manuel Martínez-S...; Pablo Díez-Villan...; Pau Vilardell; Alessandro Sionis; Miquel Vives-Borrás; Juan Sanchís; Jordi Bañeras; Agnès Rafecas; Cinta Llibre; Javier López; Violeta González-...; Àngel Cequier
• Keywords: Male; Gerontología; Frail Elderly; Enfermedad cardiovascular; 610; Hemorrhage; frailty; Comorbidity; elderly; Risk Assessment; 03 medical and health sciences; 0302 clinical medicine; 616; Valoración geriátrica; Humans; Síndrome coronario agudo; acute coronary syndromes; Prospective Studies; Registries; Acute Coronary Syndrome; Geriatric Assessment; Aged; Aged, 80 and over; 2. Zero hunger; Inpatients; bleeding; Troponin; 3. Good health; comorbidity; Area Under Curve; Female

Background Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. Methods The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton–Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). Results Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). Conclusion Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal.